Measuring constrained choices: Sexual and reproductive health decision making among rural Malawians
How women make sexual and reproductive health decisions is profoundly important for prevention of unwanted pregnancies and HIV transmission and acquisition, but is not well understood. In Malawi, one of the poorest countries in the word, HIV prevalence in reproductive age women is around 13%, and the average number of children per woman is 5.7, despite a preferred average of 4 children. We have, in our clinical and public health tool-boxes, technologies for prevention of disease and promotion of well-being for sexual and reproductive health, including contraception to prevent unwanted pregnancy, condom use to prevent STIs, and tests and medications to identify and treat HIV. These technologies are underutilized. While access (availability and cost) are barriers, the largest barrier between technologies and their use is whether people decide to use them. For many people, these decisions take place in a context of poverty, uncertainty, and misinformation. With partners in rural Malawi, we are conducting a prospective study, applying decision science to understand sexual and reproductive health decision making among Malawian women and men.
